Primary care out-of-hours service
Podcast transcript
We’re here today to talk to Claire Sweeney, portfolio manager at Audit Scotland, about Audit Scotland’s latest report Primary care out-of-hours services.
So Claire, What’s this report about?
Our report looks at how primary care out-of-hours services are provided, which is care when the GP surgery is closed. From the end of 2004, following the introduction of the new GP contract, GP practices were able to give up their responsibility for 24-hour care for their patients. Responsibility then passed to NHS boards which had to put other arrangements in place to deliver primary care out-of-hours. Our review looked at the effect of this change on how out-of-hours services are now delivered.
And what have you found?
We found that the NHS has worked hard to maintain out-of-hours services to patients, and most patients are satisfied with the care that they get according to our survey results. But with fewer GPs willing to work out-of-hours there is a significant risk that the service is not sustainable in its current form. The NHS needs to address this and consider how to involve other healthcare professionals and agencies as appropriate, such as paramedics and nurses.
What’s the impact on this for patients?
The introduction of NHS 24 means that patients access out-of-hours services in a different way. They now have one point of contact to either get advice or be transferred to other parts of the NHS as appropriate. We found that more than 80% of patients we surveyed were happy with the care that they received out-of-hours, and that included from calling NHS 24 to receiving advice at a local out-of-hours centre.
The GPs have opted out of providing care, so what should someone do now if they’re sick or they’re looking after a relative who’s ill?
If someone is ill during the out-of-hours period, they now call NHS 24 and they will receive advice about what to do. This may be getting advice over the phone from a nurse or GP about the problem, organising a home visit from a GP, or advising them to go to a local out-of-hours centre or to A&E.
Although a lot of GPs are no longer responsible for providing 24-hour care, many of these GPs still work during the night and at weekends covering out-of-hours sessions for NHS boards.
You mentioned earlier that the system may not be sustainable. What are your reasons for saying that?
Although the NHS has worked hard to deliver out-of-hours services we have highlighted the risk that these services are not sustainable in its current form. Five of the six NHS boards where we carried out detailed fieldwork said that they can find it difficult to fill GP rotas in the out-of-hours period. There is also a general trend of fewer GPs providing out-of hours-care. The NHS needs to better plan how these services can be developed. For example, it should extend the roles of other healthcare professionals and look at how to better integrate services such as NHS 24, the ambulance service, A&E departments and GP out-of-hours cover.
Also, GPs are no longer required to provide out-of-hours care. Under the new arrangements health boards can centrally coordinate the services provided which means there is potential for a greater degree of transparency around how services are delivered.
What do you want to see happen now?
We want to see the Scottish Executive and NHS boards make a number of changes to develop out-of-hours care so it is fit for the future and sustainable. This includes extending the roles of other healthcare professionals and developing new models of delivering care. Boards should develop how they work with partners such as NHS 24 and the Scottish Ambulance Service.
We want to see better planning by the Scottish Executive for major service changes. Although our report shows that work has started to involve other healthcare professionals in out-of-hours services and to develop better links with other agencies (such as A&E and the ambulance service), we highlight the need for a greater focus on planning how best to deliver services before the changes are implemented. We also highlight that there is not sufficient monitoring of the impact of the changes to out-of-hours services on patients; to date, most measures have focused on health boards’ processes for delivering the service.